Going Clear: Introducing Advanced Treatments for Adult Acne

by Marie Veronique

Welcome to the new era of acne, where more and more people are experiencing break-outs for the first time as adults, with acne even continuing into one’s fifties and sixties.  According to the Journal of American Academy of Dermatology, 54 percent of women older than age 25 have some facial acne.  Yet research at The International Dermal Institute indicates that acne arising in adulthood is different than the type plaguing teenage years: adult acne is more likely to be inflammatory with lesions primarily located around the mouth, chin and jaw line and fewer comedones (or whiteheads).

This research positing a different type of acne supports the findings of Kristina Holey, facialist extraordinaire.  A typical client of Kristina (the Kristina of the Kristina Holey + Marie Veronique collaboration) presents with symptoms that fits the description above: some type of atopic dermatitis (frequently perioral), jawline acne and facial redness, dryness and irritation.  If you are in your late twenties to early forties and this sounds familiar, join the growing throng – and keep reading to get to the good news.

About two years ago, Kristina brought to my attention the repeatability of the symptom clusters she was seeing in her clients—and I started noticing how many of my customers were similarly afflicted.  We were looking at a near epidemic of a distinctive type of adult acne among, predominantly, thirty-something aged women.

Many of our clients were additionally stressed by treatments that seemed to be aggravating their problems. All too often mainstream treatments, such as steroid therapy, benzoyl peroxide and antibiotics, deliver short term gain at the price of undesirable long term consequences. Not surprisingly, treating symptoms while ignoring causes can create difficulties: steroids suppress inflammation for a time, but can also trigger that inflammation coming back with a vengeance, making successful treatment of conditions like rosacea almost impossible. Benzoyl peroxide controls Propionibacterium acnes, but prolonged use can cause skin photosensitization and accelerated aging. Lastly, the ever-popular antibiotics disrupt microbial balance, which will likely create more inflammation over time.

We decided we needed something that didn’t presently exist, so for the last two years, Kristina and I have worked to develop products specifically aimed at treating the various manifestations of adult acne we were seeing.  

We agreed that the best place to start was to search for underlying causes that conventional treatments were not addressing. The problems adults were experiencing didn’t fit the usual etiology of acne vulgaris found in teenagers, where excess sebum and dead skin cells clog pores, leading to Propionibacterium acnes over-colonization and the spread of infection and inflammation. Adult acne tended to be more of a mixed bag: while there was sometimes congestion related to hormonal jawline breakouts, the perioral dermatitis and overall inflammation without the lesions suggested other contributing factors. To complicate matters, adults often come to us with a combination of skin conditions in addition to their acne (such as rosacea) which made treatment more challenging than with teens, who generally have more resilient, uniform, and oily skin.  

In observing hundreds of people, we developed a few conjectures -

  1. Jawline acne suggests hormonal involvement related to clogged pores and P. acnes overgrowth
  2. The presence of atopic dermatitis suggests barrier impairment
  3. Inflammation might be related to severely disrupted microbiomes, both skin and gut, related to prolonged overtreatment as well as other factors

From these hypotheses, we created products and protocols that sought to alleviate the “new” adult acne in its various and sundry manifestations.  We wanted to give adult acne sufferers more choices than the limited number of antibiotics and benzoyl peroxide that are still being used today, as they were forty years ago, but above all we wanted to broaden the scope of investigation into effective acne treatments that centered on adults.

Ingredients that help with adult acne and why

Hormonal acne

Virtually all acne formation is linked to hormones—so most of us notice at least some at the onset of puberty, when hormones start triggering sebum production that can lead to infection and inflammation.  Men produce enormous amounts of testosterone and one of its by-products, sebum, during their teenage years.  Once the puberty storm settles down, their skin tends to clear up though they may continue to have mild break-outs because they have more sebaceous glands in their skin than women.  Women, on the other hand, have to deal with fluctuating hormones. Different periods in their lives, like puberty, perimenopause and menopause, can turn previously clear skin into a landscape of clogged pores, whiteheads, blackheads and blemishes.

Ingredients that regulate sebum -

  1. Retinol, which reverses photoaging damage while clearing up acne, is every adult’s best friend (except if you are pregnant or nursing). They regulate sebum production and lead to smoother skin with fewer wrinkles.   
  2. Vitamin B5 (pantothenic acid) applied topically, in addition to Vitamin B5 oral supplements, can help adults struggling with hormonal breakouts by regulating sebum breakdown.

Ingredients that clear clogged pores -

  1. Salicylic acid (generally derived from willow bark  or other natural sources) is a beta hydroxy acid that works from the outside in to dissolve protein, and is very effective at clearing congestion.  
  2. Oils high in linoleic acid (Omega-6 EFAs), can clear pores clogged with sebum associated with low linoleic acid levels.  Besides breaking up sebum, oils create a follicular environment that inhibits P. acnesgrowth.  Omega-6 rich oils like safflower and sunflower are ideal; stay away from coconut oil, which can be comedogenic.

Atopic Dermatitis

Part of the dermatological canon is that barrier function impairment is one of the major causes of atopic dermatitis.  Since the International Dermal Institute’s assertion that some sort of atopic dermatitis, especially perioral or seborrheic dermatitis, is increasingly a feature of adult acne it leads to the obvious corollary: growing numbers of adults are suffering from barrier malfunction.  

The stratum corneum (SC), the top five layers of the epidermis, make up the barrier layer responsible for regulating moisture levels in the skin.  Compromised barrier function is governed by a variety of factors: aging, daily wear and tear, external skin stressors such as over-exfoliation and use of antimicrobial products, and internal factors such as nutrient-poor diets.  Topical ingredients that supply the SC with the building materials it needs to create and maintain its protective barrier suggest themselves as a partial solution to barrier malfunction.

Ingredients that improve barrier function -

  1. Sodium PCA and other compounds that make up NMF (the natural moisturizing factor) keeps SC cells plump and skin hydrated.
  2. Barrier lipids like cholesterol, ceramides and fatty acids.

Inflammation

Inflammation is the root of all evil, implicated in everything from arthritis to skin aging.  We are seeing more and more dry, irritated and inflamed skin, which we attribute to overuse of harsh exfoliants, skin products that contain strongly anti-microbial preservatives, anti-bacterial acne products and so on.  Teenage skin can weather these daily insults, but adults too often end up with a variety of complaints, from rosacea to inflammatory acne.  Adults with inflammatory acne especially do not want to dry the skin with harsh exfoliants, or disrupt microbial balance by using too many anti-microbials.  

Ingredients that reduce inflammation -

  1. Retinol—among all its other claims to fame, it is also anti-inflammatory.
  2. Niacinamide— Vitamin B3 applied topically helps adults deal with acne that looks less like breakouts and more like inflammation.  
  3. B vitamins— No one ever gets enough B vitamins..  Besides acne, other skin conditions such as sensitivity to sunlight, cracked lips, dryness, wrinkles, rashes, and hyperpigmentation can signal a B-complex deficiency.
  4. Probiotics--Topical applications of probiotics help balance your skin microbiome.  If you like yoghurt, you can cleanse with it and the lactic acid will gently exfoliate.  To cleanse, take ½ tsp full fat, organic yoghurt (look for a list of active bacterial cultures on the container), spread on face, rinse.  For a mask, take ½ tsp yoghurt, spread on face, leave on 15 minutes, then rinse. You may add a dash of Nutritional Yeast to the mask to supply the extra B vitamins, and a dash of turmeric to control inflammation.  For a moisturizer, take 1/4 tsp yoghurt, spread on face, leave on overnight.

Daily Routine

For daily regimens with product suggestions that can be used by adults who have acne in addition to being concerned about aging click below. 


2 Responses

Hi Debra,

Good idea to start with a nutritional adviser. You might want to go to the Acne Answer for some advice on supplements, and since you are sick of products, and who can blame you, check out the DIY sections of the Acne Answer. There are plenty of things you can do at home. I would continue taking the Retin-A though.

Marie Veronique Nadeau on November 07, 2017

I am in my late 50’s. Suffering from acne on my chin, dryness and sensitive. Would like to try your products. My derm put me on Retin A and suggested laser for redness. I am frustrated with products. I have started to work with a holistic nutritionist to help with gut issues and food sensitivities such as gluten, soy and dairy allergies, plus chicken/egg. I would appreciate where to start.

Debra

Debra Pano on November 07, 2017

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